Healthcare Provider Details

I. General information

NPI: 1235575317
Provider Name (Legal Business Name): JESSICA L REID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FAIR OAK ST
LITTLE VALLEY NY
14755-1120
US

IV. Provider business mailing address

3804 GOWANDA ZOAR RD
GOWANDA NY
14070-9733
US

V. Phone/Fax

Practice location:
  • Phone: 716-938-6499
  • Fax:
Mailing address:
  • Phone: 716-532-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number018166-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: